Tuesday, March 31, 2015

Diagnostic tests for infertility

Diagnostic tests are a key part of medical practise today and doctors rely on these in order to make the right diagnosis for the patient, so they can start the correct medical treatment. Tests are a standard part of the workup of any medical problem, and most doctors follow a protocol when treating patients. This is true for infertility as well, and there is a long list of tests which can be ordered to evaluate an infertile couple.

These include the following:

sperm DNA fragmentation test

hysteroscopy

antisperm antibodies

antiovarian antibodies

chromosomal study

NK cell testing

TORCH tests

TB PCR

The problem is that there is a wide variation between the testing protocols which different infertility clinics use. Some doctors will order a huge battery of tests for all their patients at the time of the first consultation . This can often be over a page long, and cost thousands of rupees. They include all kind of exotic, expensive and esoteric tests, such as tests for immune function, and genetic tests. This is the " one size fits all " , check-box, bureaucratic approach most large clinics follow , because they have to make sure their junior doctors will follow the protocols blindly. They cannot afford to allow these doctors any discretion in their decision making process, because they are scared that patients will fall through between the cracks. While this approach allows for standardisation, it's very unfair to the patient, most of whom end up wasting a lot of money on unnecessary tests which they don't need.

Some will be selective in their approach, and while they will order only a few basic tests for most couples, they order many more for patients who have failed an IVF cycle.

We have a much simpler approach ,and order only 4 tests, to test the four key components necessary to make a baby - sperm, eggs, fallopian tubes and a uterus. These tests are

semen analysis

blood tests for FSH,LH,PRL,TSH and AMH

HSG ( hysterosalpingogram)

vaginal ultrasound scan

This means we can complete the tests in 10 days, and determine the reason for the infertility at a cost of less than Rr 10000 ! We prefer using a well-defined sharp-shooter tactic, rather than adopting a shot gun approach, because all the unnecessary tests often end up creating a lot of unnecessary anxiety.

Many clinics prefer ordering lots of tests, because this is much more profitable for them.

We also we need to remember that doctors need to consider the patient's personal preferences when ordering diagnostic tests.

Some patients want all the tests done because they feel that this shows how thorough and efficient the doctor is . Many doctors are happy to pander to their wishes, because this means more money for them. Not only do the tests cost quite a bit, it is a mathematical certainty that the more the tests we run, the greater the number of " abnormalities " we will find , which we can then "treat" . Also, many doctors are happy to play a game of oneupmanship , and they order lots of tests in order to prove to the patient how much smarter they are than the earlier doctors, who failed to " diagnose " all these problems ( such as anti-ovarian antibodies " !)

There are also many patients who get upset when the doctor orders too many tests - or when he insists on repeating the tests from the lab he recommends. They feel , quite correctly, that the doctor is wasting their time and money !

This is why it's so important that doctors have a well-organised, systematic approach when doing tests for the infertile couple. If you find your doctor is confused, or seems to order tests on an ad-hoc basis, you must learn to speak up and ask your doctor why they are doing the tests, so that you know exactly what's happening, and why ! Tests can have side-effects, and the best way of preventing these is by arming yourself with information about when the tests can be useful, and when they can be harmful !

The harm of doing tests is that they distract the doctor, who is then more interested in fixing the abnormal test result, rather than in treating your infertility . In our clinic, we adopt a success based approach, where our focus is on creating solutions which bypass problems, rather than on finding problems !